It's a brand new world for each generation. What appears to be
remarkable for one generation may be ordinary for the next. When
I got into the infertility field, in vitro fertilization was a
therapy for married couples only where the woman had blocked
tubes. We've come a long way, baby. Test tube babies are no
longer extraordinary. Infertility is no longer a big secret, and
there are articles and resources available. This next generation
will grow up in a world where IVF is standard operating
procedure for infertility.

Are surrogacy or gestational carrier programs standard operating
procedure for the next generation? Hardly. But will this next
generation react to surrogacy and gestational carrier in the
same way as current generations. I doubt it. Families have
changed in the 1990's. Families are made up of kids with just
moms, kids with just dads, kids that were adopted, kids that
were adopted from another country, kids with grandparents, and
kids with a mom and a dad. Watch Sesame Street and you will know
that today's generation understands that a family is a group of
people that live and love together. I am impressed with how
generations see things differently.

Surrogacy and gestational carrier make up different kinds of
families and I have had the opportunity to watch these families
come to be over the last decade or so. The need for surrogacy
and gestational carriers has also grown as men and women who
wish to have a family are educated about the options of both
surrogacy and gestational carrier.

It always strikes me that people are surprised by surrogacy and
treat non-biological parenting as something brand new. Hardly.
Since the beginning of time, we have had the capacity to care
for children that are not ours genetically. And, since the
beginning of time, we have had the capacity to give to others
and care for each other as a community. It is pregnancy and
genetics that we hold sacrosanct - a completely different entity
from any other life experience.

I have come to observe that pregnancy and parenting is on a
continuum not in discreet categories as most people observe.
People feel very different about their gametes, their eggs and
sperm, and people certainly feel very differently about
parenting. In our program, we have both a gestational carrier
and ovum donation program. Most of the women who volunteer to be
gestational carriers have told me they would never consider
and/or feel comfortable donating their eggs but have no problems
carrying a pregnancy. Most of the women who volunteer to be ovum
donors would never consider being a gestational carrier or a
surrogate.

Indeed, research has shown that people feel very differently
about what infertility treatments they would consider. Some of
us would never consider fathers donating sperm to sons, yet
others see this as the best option. Culture plays a huge role on
what reproductive options we would consider. Research also shows
us that it is not age, religion, or gender that plays the
biggest role on how willing someone is to consider using third
party reproduction such as a donor or surrogate or carrier -it
is personal experience with infertility. A simple show of hands
in any lecture room would most accurately predict whether you
would be willing to consider using a surrogate. By the way,
having experience with infertility through a friend or family
member is not good enough. The impact is truly made when you
have personal experience.

But surrogates and carriers don't have personal experience by
definition. So the most commonly asked question of me as a
psychologist is "Why on earth would a woman do this?" A fair
question. In her 1994 book, anthropologist Helena Ragone
summarizes the issue nicely "Until now the image of surrogate
mothers has been principally shaped by media, legal, and
scholarly portrayals of them either as motivated by monetary
gain or as unwitting, naively altruistic victims of the
patriarchy, mother who have been coerced into giving up their
babies". (page 52)

Previous research has looked at the stated motivations of
surrogates and carriers. Obviously, statements included a wish
to help others, etc.... Overall, it is a strongly held belief
that the surrogate or carrier can make a difference in the
world. E.g. I may not find a cure for cancer.....

The media always likes to cite that surrogates and carriers are
motivated by remuneration - though the women place this usually
last on their lists of motivations. My experience is that
compensation is part of the motive but not the main motive.
Motivation is made up of many reasons. The desire to be a
surrogate or carrier is not constructed from a single fabric,
rather it is stitched together in a patchwork quilt.
Compensation may be part of the pattern. Often the money is
targeted to help the carrier's own family. Carriers feel that
the compensation is earned for the discomforts and risks of
pregnancy.

What has emerged is the concept that motivation for compensation
constitutes a "bad" carrier while uncompensated carriers are
"purer" or more altruistic. There is no research that has come
to this conclusion. The carrier/surrogate does receive what she
perceives as many rewards for her participation. Money may be a
part. Another part may be the chance to be pregnant again.
Another may be the chance to truly make a difference in another
couple's life or to forge a unique friendship. Certainly,
participation as a carrier or surrogate is exciting - different
from the humdrum part of everyday workaday life as a homemaker
or worker. These women see themselves as very capable,
intelligent individuals who understand the risks and benefits to
being a volunteer carrier or surrogate. The paternalistic
viewpoint that they should be protected from themselves angers
them.

Counseling is, therefore, an essential part of the surrogacy or
gestational carrier process. For if women are truly considered
capable of making their own informed choices, which I beleive
they are, then they must be able to have the full information
before getting into the surrogacy or gestational carrier
situation.

Potential parents and carriers need to understand the emotional,
legal, and medical demands of their programs. As best as
possible, parents and carriers need to work out ahead of a
pregnancy what type of relationship they would like to have
together during pregnancy and after the child is born. Do the
parents intend to tell the child about his or her origin -
genetic or gestational? Most of our parents start a baby book
with a picture of the embryo and a picture of themselves and
their carrier in the recovery area after embryo transfer.

The carrier/surrogate needs to anticipate their feelings ahead
of a pregnancy. I always tell these volunteers that it is easy
to imagine the "good stuff", but it is our job to try to
anticipate the less glamorous and "hard stuff" of going through
this experience. We address how her children may be effected. To
date, the children of the carriers we work with have had little
difficulty with the issue of mom carrying a baby for someone
else. But there is little empirical data to address this issue.

Among the issues that are raised and explored are:

-what will this pregnancy be like for the woman and her partner?
-how will her children react?
-how will the carrier or surrogate help her children deal with
their feelings?
-how will her family react? her community react?
-is there anything in her psychosocial history that may
effect/influence her experience?
-what feelings will arise during the pregnancy towards the baby?
-what are her expectations from the experience?
-what if she does not get what she wants emotionally out of the
program?
-what if she does not get pregnant?
-what if there is a multiple pregnancy?
-what will it be like if she has medical complications with the
pregnancy?

These are only some of the questions that need to be raised. In
addition, in our gestational carrier program, the evaluation and
counseling is an ongoing process. Indeed, feelings change over
time and through experience, and carriers/surrogates need to
have the opportunity to explore these new and different feelings
as events unfold. We have had volunteer carriers who have
elected to discontinue participation because events in their
lives changed or because they tried multiple cycles
unsuccessfully or other reasons.

There are emotional risks to everything we do in life. Certainly
I would not suggest that choosing to be a carrier or surrogate
is risk-free. I do believe that counseling can reduce the risks.
The best analogy I have is dating and marriage. Every day,
couples get married believing, hopefully, that this relationship
has the ingredients necessary to make a life commitment. Every
day, couples get divorced realizing that the relationship has
failed. In a surrogacy or gestational carrier arrangement, it is
critical that both carrier/surrogate and intended parents alike
realize that the relationship may not meet their expectations
and be willing to take that risk. Even when the relationship
fails, both surrogate/carrier and intended parents need to be
willing te work together to meet the basic needs of the child.
If there is no pregnancy, then the group must have the courage
to end the relationship and work with someone else who better
meets their needs.

Ultimately, gestational carrier and surrogacy relationships are
based on trust. Although we do ongoing psychological screening
and counseling on both carrier/surrogates and on the parents,
the process is dependent upon everyone doing what they say they
will do. Carriers/surrogates trust that the parents will want,
love and take care of this baby and take care of the
carrier/surrogate emotionally, and the parents trust that the
carrier/surrogate will take care of the baby by taking care of
herself physically.

There is not enough time to go into the myriad of details of the
psychological issues surrounding gestational carrier and
surrogacy. Let me leave with you with some of the words from the
women who applied to our program when asked what message they
would write to the child(ren) born through their participation
as a gestational carrier:

"Dear Child,

Several years ago I became close friends with a very special
couple. Their love for one another was so strong that they
decided to make a new life to share this live with. Their love
for this life was indeed so strong that they decided to include
me in their lives so that this life could be possible. This was
a wonderful experience for me. It brought new friends into my
life and helped fulfill a need of mine to contribute my time in
helping other people to achieve their dreams. This experience
happened over eighteen years ago and if I had to, I would do it
all over again. God gave you parents' love a new life and at the
same time touched mine.

Love Always,"

"Dear Child,

The day you were born - WOW! What a very special day. You see, a
lot of great people had something to do with this day. The most
important ones - being your parents. They wanted you for so long
and tried so hard. But sometimes people can't do things alone
and they need help. That's where I came along. By now I've
already had my children and am very happy with the ones I've
got. I couldn't imagine not having them in my life, just as I
couldn't imagine not being able to have any children. Then I
learned I could help another couple fulfill their dreams of
having a family and that couple was your parents. And through
the wonderful world of medical research and the doctors who
specialize in making dreams come true - you were born.

And even though I have given birth to you, it is your parents
who gave you life - which we all celebrate today!